Wednesday, October 17, 2012

Dr Malpani, should I complain about my doctor ?

Every doctor wants to see his patients get better. After all, one of the major reasons people choose to become doctors is that they have a strong urge to heal and help others. Medicine is the ultimate service profession, and because it's a direct one-on-one relationship, good doctors devote a lot of their time and energy in keeping their patients happy.

It also make a lot of business sense to do so. Patients who are happy are the best source of new patients ! Word of mouth marketing is the best was of growing a practise for doctors , and doctors understand the value of this.

This is why happy patients make for happy doctors !

Unfortunately, not every patient is going to do well. Medicines do not always work and the human body can be fickle. This is especially true in IVF cycles, when the outcome of the cycle is always outside the doctor's hand. No matter how good a doctor I am, once I have made the embryos in the IVF lab and transferred them into the uterus, I have no further control as to what will happen. Sadly, most embryos do not become babies, which means IVF cycles are more likely to fail than to succeed.

This is a fact of life, and we do our best to educate and prepare our patients for this possibility. This is why we are transparent; show patients photos of their embryos ( even when things are not going well); and prescribe large doses of Information Therapy, so that patients have realistic expectations of what we can do for them.

Our patients appreciate our efforts , but when an IVF cycle fails , patients are understandably upset. If an IVF cycle fails, the right thing for a smart patient to do is to analyse the cycle together with the doctor. What went wrong ? What went right ? What can we do differently the next time ?

Sadly, not all patients are capable of taking such a mature approach. They are angry and need to vent and a doctor is an easy target ! Some get abusive ( both in real life and online); and others may even get violent. Rather than sit dispassionately with their doctor , they often end up bad-mouthing him and end up damaging a reputation which may have taken a lifetime to earn, because doctors are easy targets. Thanks to the internet, it's become very easy ( too easy , I feel) for patients to post anonymous complaints online about their doctor. While it's important to allow patients mechanism for redressal, I do not think anonymous complaints are the right way to do this. If the patient has a complaint, he should also have the courage to stand up and identify himself, so the doctor can explain what happened.

I have been at the receiving end of anonymous online complaints , and feel betrayed. We pride ourselves on our patient-centric skills. However, even though we spend so much time with our patients, counselling them and educating them, when they say nasty things about us behind our backs, without giving us a chance to provide an explanation , I am angry and upset ( which is one of the reasons I am writing this post ! ) These cowardly complaints are very upsetting. The most sensible thing for me to do is ignore them , but it's hard for me to do this, because I care for my patients, and am unhappy when they are unhappy. It's hard for me to detach myself and not take it personally. I pride myself on my patient-skills and think of myself as being a good doctor. This kind of unfair criticism hurts !

What's worse, this sets up a negative vicious cycle . Doctors who have been abused by angry patients often start becoming angry and resentful themselves. They start practising defensive medicine and distancing themselves from patients, to protect themselves. Also, doctors talk amongst themselves - and what they learn from other doctor's experience is that patients can be vengeful ( for no fault of the doctor's) - and that doctors need to protect themselves from their patients !

It's so tragic that affairs have come to this sorry state . A lot has been written about how the doctor - patient relationship has deteriorated in recent times. While many people are happy to blame greedy doctors for this, unfortunately no one has highlighted the role patients play in damaging the relationship. After all, any relationship is a two-way street - and a doctor who has been sued or abused is no longer going to be the same person he was before the episode.

Unhappy patients create unhappy doctors . What's worse, they often end up creating unhappy patients as well, because unhappy doctors do not take good care of their patients and often end up disrespecting them and providing poor quality care.

The tragedy is that the bad doctors - the ones who are mercenary and uncaring really don't care what their patients think about them. Criticism from an unhappy patient just rolls of their back and they can happily ignore it. Good doctors are hurt when patients are unhappy with them, because they have worked hard in order to get the patient to get better. They feel cheated and let down that the patient has abused them rather than tried to talk to them to resolve the problem. Their attitudes towards the next patient they see hardens - and the doctor-patient relationship starts deteriorating and becoming adversarial !

If you are unhappy with your doctor , please do let him know so he can try to fix the problem. You owe this to your doctor; yourself; and to his future patients ! Of course, if he does not do anything to solve your problem, then it's fair to look for ways of getting back - but never attribute to malice what may have happened because of factors outside anyone's control !